Evaluation of uterine bleeding after an endometrial ablation

Chetna Arora, Daniel M. Breitkopf, Matthew Hopkins, Abimbola O. Famuyide, Tatnai L. Burnett, Isabel C. Green, Shannon K. Laughlin-Tommaso

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To determine the feasibility of evaluation of abnormal uterine bleeding after endometrial ablation with hysteroscopy, transvaginal ultrasonography (TVUS), and endometrial biopsy (EMB). STUDY DESIGN: Retrospective cohort. RESULTS: From 2000– 2015, chart review identified 206 women with abnormal bleeding post-ablation, of which 53 (25.7%) opted for a hysterectomy with no further evaluation. Of the remaining 153 (74.3%), evaluation post–endometrial ablation was performed by EMB (n=76), TVUS (n= 106), sonohysterogram (n=15), and/or hysteroscopy (n=66). Successful EMB (defined by presence of endometrium) post-ablation occurred in 64 patients (84.2%). Hysteroscopy was successful (defined by visualization of the uterine cavity and a sounding length of ≥4 cm) in 93.9% of patients; bilateral tubal ostia were seen in 27.3%. Successful sonohysterography (defined by the ability to distend the cavity, identify fluid pockets, and visualize the endometrial stripe) was accomplished in 26.7%. TVUS resulted in the presence of a visualized endometrial stripe in 75.5% of patients. In those who underwent hysterectomy, post-ablation EMB and TVUS were consistent with histology and gross pathology. All of the patients (n=2) with endometrial neoplasia (1 atypical hyperplasia and 1 adenocarcinoma) were iden-tified by post-ablation EMB. CONCLUSION: For women who present with bleeding post-ablation, EMB, hysteroscopy, and TVUS are valuable tools to rule out malignancy and intracavitary pathology. (J Reprod Med 2020;65:157–163).

Original languageEnglish (US)
Pages (from-to)157-163
Number of pages7
JournalJournal of Reproductive Medicine
Volume65
Issue number3
StatePublished - 2020

Keywords

  • Abnormal bleeding
  • Catheter ablation
  • Endometrial abla-tion
  • Endometrial ablation techniques
  • Endometrial assessment
  • Endometrial neoplasms
  • Endometrium
  • Heavy menstrual bleeding
  • Post-ablation
  • Uterus/ diagnostic imaging
  • Uterus/surgery

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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  • Cite this

    Arora, C., Breitkopf, D. M., Hopkins, M., Famuyide, A. O., Burnett, T. L., Green, I. C., & Laughlin-Tommaso, S. K. (2020). Evaluation of uterine bleeding after an endometrial ablation. Journal of Reproductive Medicine, 65(3), 157-163.